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Sunday, November 11, 2012

Me? Defending Prescription Drugs?

A dear
friend, Caroline*, recently announced that she chooses to live her life without
prescription drugs. A few years ago, her doctor told her she had high blood
pressure, and advised her to begin a regimen of blood pressure medication.
Caroline never went back to the doctor, and currently has no firm plans for a
checkup.

When I read this declaration on her popular blog, I was stunned and
worried about this woman, a lady with an extraordinarily beautiful soul, who is
as precious as a sister to me. Although I share some of Caroline’s views that
prescription drugs can possibly cause harm and prolong life without maintaining
an acceptable quality of life, I hope I can convince her to rethink her choice
to avoid doctors and completely refuse any prescription medicine.

In her
post, Caroline cites the experiences of her brother and father. Both men died
too young. Her brother underwent a time of kidney dialysis, until his life was
an endless round of visits to the dialysis center. His quality of life was
miserable, and he finally chose to refuse treatment. Caroline’s father began
his decline with the simple step of taking blood pressure medicine that led to
more and more prescriptions, and death at 67. Knowing Caroline’s loving nature,
watching these adored family members succumb to ill health was heartrending and
hellish for her.

She has
a valid point when she rebels against the idea that there is a pill for every
minor-to- major blip on our health radar, and that sometimes the smart thing to
do is to say no or at least get a second opinion before embarking on drug
therapy. Our nation is awash in a sea of pills. With a Walgreens, a CVS, or a
Rite Aid on nearly every corner, drug ads on prime time TV, and even children
taking prescriptions in record numbers, we are over-medicated, as Caroline
implies. Having had some unfortunate experiences with drugs, I can understand
why she is wary of being made sick from prescription pills.

My own
best example of prescription troubles started when I was in my late forties and
was diagnosed with slightly elevated cholesterol. My doctor prescribed statins,
and I remember being hopeful that these common drugs would lower my lipids. After
all, many people take statins, they are considered safe overall, and some
doctors believe so strongly in them that they propose adding them to the public
water supply! At this time, I also got serious about my diet, added more
exercise, and lost twenty pounds, bringing me into a healthy BMI. Proud of my
lifestyle changes and sure that along with the statins, my cholesterol levels
would be the envy of all, I had another blood test. My cholesterol had gone UP!

First, I
was incredulous, then dismayed and discouraged. How was this possible? My
physician, Dr. D., was unconcerned, and told me that some people had hereditary
high levels that were stubborn to treat. Over the next eight years, she tried
me on four different statins, and on increasingly higher doses. At
the highest dose of the strongest statin, my back, wrists, and muscles began to
ache. Brushing it aside as too much time spent commuting and working at the
computer, eventually I complained to Dr. D. She advised me to stop the statins,
and a scant week later my painful back, joint and muscle pains disappeared.

The
pain that I thought might be my lot to bear for the rest of my life—after all,
old people have aches and pains, right?—had been caused by the pills that were
supposed to make me “well.” The statins had caused me to ache all over, and had
NOT reduced my cholesterol to “healthy” levels. This experience shook my faith
in the marvels of supposedly safe modern drug therapies.

So I
approach any prescription drug with caution, and with the thought that if the
drug does not accomplish its stated goal within a reasonable amount of time and
with a minimum of negative side effects, it’s time for a second opinion. But I
feel bound to add that over-the-counter drugs, vitamins, and herbal supplements
need much the same caution. Tylenol can be deadly to the liver, vitamins can be
toxic at too high levels, and herbal supplements should be considered as
potentially as powerful, and as prone to unpleasant side-effects or
interactions as any prescription drug.

We can’t
be passive consumers; we must do our research and due diligence. It exhausts me
to put so much thought into health, but I haven’t found a shortcut around
working with my doctor while also trying to stay reasonably well informed about
any drugs she prescribes. Additionally, I attempt to keep up with ongoing
research for my health conditions. Alternative
therapies can help in some cases—I also get therapeutic massage and I’ve tried
acupuncture.

After my
sobering experience with statins, one might expect that I am living a happy-go-lucky,
drug-free life. I was, for about six months. Then some other conditions reared
their ugly heads; I now take 3 prescription drugs on a daily basis. I’m not
thrilled, but I have realized that my current prescriptions are necessary for
me to function. The drugs keep me going; without them, I would not be able to
work, to be here for my husband, or for my aging mother.

I used to have
concerns, as Caroline does, about “what if I have to stay on these drugs the
rest of my life?” For me, and for many people, if prescription drugs are what
it takes, so be it; we are resigned. Sometimes, we’re even grateful. At least
these drugs are available, and the alternative for me is near complete
disability. Without these drugs, there would be no “rest of my life” to worry
about.

Further,
I would tell Caroline that yes, she is her own woman and she has the right to
refuse treatment. We have the freedom to choose how to live, and how to die. However,
she is not an island. She has a loving husband, children, grandchildren, and many
friends who all love her. We don’t want her to die too young. We don’t want her
to suffer anything remotely near the fates of her father and brother. We do
want her to consider finding a doctor she has can develop a trusting
relationship with, and who in turn
answers her questions about high blood pressure, possible treatments, and
recommended lifestyle changes.

We want
this for her not because we are trying to tell her what to do or because we are
trying to make her feel guilty, ashamed, or unreasonable for her choices. We
want her to be WELL, to live a long
time among us, and when the time comes, to be able to have a dignified,
pain-free death.

Prescription
drugs are not inherently good or evil. They are chemical compounds, as are OTC
drugs, herbal supplements, and the food and drink we consume daily. Our own
physical bodies, at the most basic level, are chemicals. Prescription drugs are
sometimes useful chemical tools that can help to decrease or delay many
diseases. Life expectancy was a bitterly short 47 years for an average American
woman in 1900 (University of California, Berkeley, n.d.). The average woman
today can expect to live 33 years longer, to over age 80. The CDC (2008) says
Caroline, as a Hispanic woman, can expect 3 years more than that, on average,
83 years!

Prescription drugs are certainly no guarantee of longer life. However,
many people would agree that when used judiciously under the supervision of a knowledgeable,
caring physician, drugs are an option we sometimes must consider. Caroline—please make that doctor appointment
soon. We love you and want you healthy, happy and with us for many, many years to come!

*not her real name

This blog is not intended as medical advice. Consult your own health care professionals for advice related to health and prescription drugs.

13 comments:

I can't imagine why someone wouldn't try a prescription drug that their trusted doctor recommends to improve something that's not right. Blood pressure in particular is a silent killer, and needs to be managed and monitored carefully.

Your experience with statins was unfortunate but not unusual, from what I understand. I have friends who are far more vigilant and careful about exercising and eating than I am who can't bring down their numbers no matter what they do, and that includes taking medication. My experience with statins has been quite different, and my cholesterol has improved dramatically because of medication. There are hereditary problems that can only be improved with medication, and cholesterol and blood pressure are two of them.

Of course we need to be careful about not overdoing medication, and must communicate with our doctors regularly, but in my opinion not taking available medications to improve your health - unless they don't agree with you or cause uncomfortable side effects - is foolish.

Hi Sharon-- thanks so much for your thoughtful comment about this post that was so difficult for me to write. I'm glad that you had better luck with statins than I did! The rest of my family has better genes than I do, so it makes me grumpy that I got the ridiculously high cholesterol gene, bah. I'm lucky to have found a primary care doctor, a woman, who is in my corner and keeps a close eye on me. That makes all the difference to me, and I hope Caroline also finds a doctor who can answer her questions and allay her concerns.

I hear you, my friend. I am the biggest bundle of fear possible when it comes to my health, lol. Often I think, why me? when it comes to high cholesterol. In desperation, feeling like I was going to croak any moment, I went to my cardiologist to ask him what to do after the statins failed. He was so kind and so honest. He said as long as I don't have any other risk factors for heart disease (and I don't, so far) that I should just not worry about the cholesterol-- just take fish oil to keep my good cholesterol high. I love that man! A caring doctor makes all the difference!

These are tough things. ALthough I strongly appreciate all your arguments to get Caroline to get checked out by the doctor, I must also say I am one who takes ANYTHING the medical establishment days with a great deal of skepticism. I suspect they mean well (most of the time) but the god complex, the arrogance of many in the health care field, makes me want to avoid them like hell. As a profession, I am appalled at the general disregard for the body in front of them as a real person, with needs, fears, and a busy life. The medical profession, again as a blatant stereotype, needs to step WAY down from their high horse. Having said all THAT, I will say that I had a professional encounter with a cardiologist this week who actually listened to ME and we both agreed that I am so not a candidate for coronary heart disease. Additionally, I had a meeting with my primary care doctor in which she entered the room and actually simply sat down on the extra chair in the room and gave me her 100% attention - WITHOUT immediately jumping in with a diagnosis, prescription and slam ,bam. thank you , ma'm attitude.Interesting topic, Melanie - I wish we could have a cup of tea over it (since I am choosing to step away from wine for now....)

How I would enjoy that cup of tea, and our chat would go on until we were both hoarse! I have had those imperious doctors in the past, so I count myself incredibly lucky to have several good docs in my corner these days. Call me prejudiced, but I am partial to female practitioners. My cardiologist is a man, but of the younger generation. He's a delightful geeky sort, who treats me like a member of the family. It's pretty miraculous to find doctors who have empathy-- glad you have!

Excellent posts from both sides. My hubbypants had trouble with a particular statin, but hasn't had any joint issues since changing brands. He would have to live off water and lettuce to control his cholesterol otherwise. My step-grandmother has such high cholesterol that even on medication hers hovers in the mid 300's, bad genes. I think that a majority of medications provide us with a comfortable, long life. There is a risk that taking a medication will lead to another one, but I think it has more to do with us aging than anything else. I would, in a heartbeat, take a prescription drug if it meant I'd be out of a danger zone or it prolonged my life - after weighing the options or trying natural methods first. My fear is that by not taking something that can, for example, help prevent a stroke that we are opening ourselves up to that very thing. I'd worry less about the stroke killing me than leaving me an invalid and being a burden to family that would have to care for me or pay for my care. If a drug drastically reduced that chance and gave me good quality of life...I'm all over it.

My family tree has quite a few long-lived people, amazingly so when you think of all the odds working against them from tooth decay to contagious diseases! So I was pretty p-o'ed to get the cholesterol news. Glad your hubbypants had better luck with the statins-- they help a lot of people. My husband,like you, has no thyroid so he takes synthroid and gets his levels checked regularly. Even my cantankerous mother takes meds for her heart rhythm (she's the one that wouldn't take a tylenol if she was delirious with fever). I hope Caroline goes for that check up, and gets a second opinion if needed. It can be scary, but she is a brave, strong lady.

Hopefully your friend "Caroline" will reconsider her treatment options. While I know she is scared because of her family history, she is much better off being treated before her situation becomes more serious. That is usually when the body is not as healthy and the medication may not be as effective. Of course, drug reactions can happen at any time. That is why taking a team approach and involving ones local pharmacist is a good idea. After all, they are the drug experts.

Loved this post for its realistic approach, especially when talking OTC offerings. There is no medication without risk, including the ones that we tend to take for granted like Tylenol. That is why every consumer should do a personal risk benefit ratio to determine if they want to take a medication or not.

If "Caroline" reads this, please know that you are loved by all who come in contact with you and we all want you to be healthy and live until past 90 years. Visit your doctor, consider your options and use information to overcome your fear of the unknown.

Thanks so much for dropping by, Elaine. I was so concerned about getting this post "right," so that Caroline would understand that I'm not trying to prove anyone right or wrong, or strong-arm her into "my way or the highway." Many of us know more than one person who prefers to avoid doctors no matter what, and many of us have had a doctor who wasn't a good fit for us. I wish I could wave a magic wand and make taking care of ourselves easier. It takes a lot of thought,sometimes shopping around for a doctor/office that is "right" and hopefully a caring team of health professionals including the pharmacist. Not easy, but we all want the best outcome for Caroline. Hugs, Ms. Elaine!

Giving in to meds is such a difficult thing. A handful of years ago, my hubby's check-up revealed that his blood pressure, cholesterol, and blood sugar were all elevated. His family history is wicked, so he took the numbers seriously, but hesitated about going the prescription route.

We changed everything. I purged the cabinets, tossed stuff from the fridge, and restocked with nothing but healthy stuff. We got off our asses. Every. Single. Day. We both dropped a bit of weight. After 30 days, his numbers were better. At 60, better still. By day 90, all were normal. Yipppeeee!

After some time, we both slacked off a little. Then more. We'd sporadically stay on track, then plunk, off. Finally, he agreed to certain scripts. We eat *mostly* healthy. I work out more than he does, but less than I should. His numbers are all good. Mine are, too. Well, except for my jean size. That number still pisses me off.

This is one of those issues--like so many issues--that come down to striking a balance. And I think you're definitely on to something with the informed consumer issue. Working in a halfway house for recovering addicts and alcoholics, I can say that a lot of the men who come here from rehabs and other medical facilities come with sheafs of prescriptions to the point where it seems the doctor at the other end was on auto-pilot rather than rationally responding to actual patient needs. Pharmaceutical companies aggressive marketing practices are a huge issue, too. But, as you said, there are prescriptions that are absolutely necessary and that make huge positive differences to individuals and their families. Balance and information are key.